role profiles for nursing staff in -...

ROLE PROFILES FOR NURSING STAFF IN EMERGENCY CARE SETTINGS IN IRELAND

Staff NurseShift LeaderNurse Manager

January 2014

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FOREWORD

This document presents a suite of role profiles for various grades of nursing staff workingwithin the Emergency care setting which are complimentary to the Health ServiceExecutive (HSE) nationally agreed job descriptions for various nursing staff grades. Partof the HSE nationally agreed job descriptions outline that nurses must ‘demonstratepractitioner competence and professionalism in order to carry out the duties andresponsibilities of the role’. In support of this, the National Emergency MedicineProgramme (EMP) Emergency Nursing Interest Group (ENIG) have developed role profilesthat provide additional or specific role details with regard to nurses practicing in theEmergency Department (ED) environment.

Each role profile outlines a role specific competency framework intended to guide variousgrades of emergency nurses towards achieving predetermined practice competencies tomeet patients’ needs in the challenging clinical environment of the Emergency Department(ED). It is envisaged that the use of these role profiles will also support standardisationof emergency nursing competencies nationally, will support performance managementand will assist management in recruitment processes.

The role profiles were prepared by ENIG and co-ordinated by Ms. Susanna Byrne, InterimDirector Nursing and Midwifery Planning and Development Unit, HSE Dublin Mid-Leinster(Palmerstown) and Service Planner for the EMP. The role profiles have undergoneextensive stakeholder consultation, and the EMP and ONMSD are therefore pleased toendorse them and anticipate that nursing staff working within the emergency setting willfind them beneficial in their roles.

Dr Michael Shannon Dr Una Geary

__________________ __________________Nursing & Midwifery Services Director, National Clinical Lead, Emergency Medicine Programme, Clinical Strategy & Programmes Directorate HSE Clinical Strategy & Programmes Directorate HSE


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ACKNOWLEDGMENT

The author would like to extend sincere thanks to the following people who havesupported and contributed to this document.

Emergency Nursing Interest Group (ENIG) members

Directors of Nursing and Midwifery Advisory Reference Group (National ClinicalProgrammes)

National Emergency Medicine Programme (EMP) Working Group

Mr Paddy Duggan, Performance Management & Management Information, NationalHR Directorate, HSE

Ms Michelle Canny, Occupational Psychologist, HSE National HR Directorate

Ms Kathleen Mac Lellan, Department of Health

Ms Joan Gallagher, National Clinical Programmes Liaison, ONMSD, HSE

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ROLE PROFILES FOR NURSING STAFF IN

EMERGENCY CARE SETTINGS IN IRELAND



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TABLE OF CONTENTS

Foreword ....................................................................................................................1

Introduction ...............................................................................................................5

Staff Nurse Role Profile ..............................................................................................7

Shift Leader Role Profile ............................................................................................15

ED Nurse Manager Role Profile .................................................................................25

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INTRODUCTION

This document presents a suite of role profiles for the grades of staff nurse, shift leaderand nurse manager working within the Emergency care setting. The role profiles arecomplimentary to the HSE nationally agreed job descriptions for staff nurse (Grade code2135), CNM 1 (Grade code 2127), CNM2 (Grade code 2119), and CNM 3 (Grade code233X).

The HSE nationally agreed job descriptions outline that nurses must ‘demonstratepractitioner competence and professionalism in order to carry out the duties andresponsibilities of the role’. In support of this, the National Emergency MedicineProgramme (EMP) Emergency Nursing Interest Group (ENIG) have developed role profilesthat provide additional or specific role details with regard to nurses practicing in the EDenvironment.

It is envisaged that these role profiles will also assist by:

Providing clarity for the emergency nursing staff and supporting the standardisationof competencies required by nurses working in ED settings nationally.

Ensuring provision of standard and quality care.

Supporting the enhancement of patient safety.

Supporting implementation of performance management in the future.

Future recruitment processes (build into professional knowledge identification atinterview).

The role profiles present a specific competency framework intended to guide each staffgrade towards achieving predetermined practice competencies to meet patients’ needsin the challenging clinical environment of the ED. The Nursing and Midwifery Board ofIreland (formerly An Bord Altranais) have defined five domains of competence which eachnurse and midwife must demonstrate in order to be registered to practice. These fivedomains of competence are used in each role profile as the building blocks forcompetence development.

The five domains of Competence:

1. Professional/Ethical Practice

2. Holistic Approaches to Care and the Integration of Knowledge

3. Interpersonal Relationships

4. Organisation and Management of Care

5. Personal and Professional Development


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Each domain of competence consists of performance criteria and their relevant indicators.A behavioural indicator is a statement of the behaviour that would be observed wheneffective competence is demonstrated. The indicators are not intended to be complete orall-inclusive but should be interpreted in the context of the specific practice setting (inthis case the emergency nursing setting) and may be further developed to address specificcontexts of practice and required competencies.

The competencies outlined within each role profile reflect the common and role specificcompetencies for ED nurses.

The Staff Nurse grade comprises of the largest group of nursing staff working in the EDand are responsible for providing 24/7 nursing care which involves assessment, planningimplementation and evaluation of nursing care to an increasingly complex cohort ofundifferentiated undiagnosed patients.

The Shift Leader in the ED has a pivotal role in co-ordination and management of activityand resources within the clinical area on a day-to-day basis. The main responsibilities areensuring delivery of safe quality patient care, resource management, service provision,staffing and staff development, facilitating communication and providing professionaland clinical leadership.

The competencies of the shift leader overlap with many of those included in the EMP RoleProfile for an ED Nurse Manager as many of the elements of the ED Nurse Manager roleare also performed or supported by the ED Shift Leader in the course of their daily work.

The ED Nurse Manager applies specially focused knowledge and skills to manage andlead a high quality service for emergency patients. The role encompasses key result areasincluding planning of services in terms of needs analysis, activities, targets and priorities,ensuring delivery of safe quality patient care and deployment of resources to includebudgeting and workforce planning. The ED nurse manager acts as a focal service contactpoint and primary liaison person with other disciplines and service collaborators andprovides direction, support and supervision to frontline staff in the discharge of their rolesand promotion of evidence-based clinical decision making.

The development of the role profiles involved wide consultation with key stakeholdersincluding, nursing staff working in Emergency settings via the Emergency Nursing InterestGroup, the Director of Nursing and Midwifery Reference Group, HSE HR, HSERecruitment, Department of Health Nursing Division and the Office of Nursing andMidwifery Services.

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ROLE PROFILE

STAFF NURSE IN THEEMERGENCY SETTING

This is a complementary document to theHSE nationally agreed staff nurse (general)job specification (Grade code 2135).



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DOMAIN 1: PROFESSIONAL/ETHICAL PRACTICEPerformance Criteria

1.1 Practices within aframework of professionalaccountability andresponsibility.

Behavioural Indicators

a) Practices within the legislation, professional regulation andguidelines relevant to his/her scope of practice andemergency care setting.

b) Holds an appropriate and effective set of professional valuesand beliefs and behaves in line with these.

c) Integrates accurate and comprehensive knowledge ofethical principles and the Code of Professional Conduct(2000) within the Scope of Professional Practice (2000) inthe delivery of emergency nursing care.

d) Promotes and consistently supports ethical and value-basedstaff practices.

e) Advocates with and on behalf of the emergency patient toprotect their rights.

f) Demonstrates knowledge of, and implements, thephilosophies, policies, protocols and clinical guidelines ofthe healthcare institution and those specific to theemergency department.

g) Utilises evidence based emergency care to improve patientoutcomes, reduce variation in practice and improve qualityof clinical decisions.

h) Responds to, and reports, all incidences of unsafe orunprofessional practice, deviations from best practice, andunethical and illegal practices.

i) Adheres to best practice in the management of patientsafety, risk assessment, risk minimisation and riskmanagement.

j) Demonstrates knowledge of the specific healthcare issuesand needs of diverse, minority and ethnic groups.

k) Participates in the teaching and preceptorship of nursingstudents on placement in the ED.

l) If a Registered Nurse Prescriber, prescribes medication (asagreed within his/her Collaborative Practice Agreement).

1.2 Practices within the limitsof own competence andensures he/she takesmeasures to develop owncompetence.

a) Determines own scope of practice using the principles inthe Scope of Nursing and Midwifery Practice Framework(2000) document and works with line manager to furtherdevelop personal scope of practice to meet identifiedservice needs and enhancements.

b) Recognises own abilities and level of professionalcompetence and seeks to enhance/improve competencewhere identified deficits exist.

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c) Critically evaluates and bases practice on best availableevidence.

d) Accepts responsibility and accountability for consequencesof own actions or omissions in caring for the emergencypatient and those of students and support staff delegated tohis/her supervision.

e) Assumes personal responsibility for maintaining anddeveloping current knowledge to provide evidence-based,best practice emergency nursing and to share knowledgewith colleagues to further inform practice development.

f) Identifies a mechanism to support personal continuingprofessional development to ensure continued competence.

2.2 Plans care in consultationwith the patient taking intoconsideration the therapeuticregimes of all members of themultidisciplinary team (MDT).

a) Prioritises care of the emergency patient based on theirimmediate needs and best/evidence-based practice andescalates patient care within appropriate time frame.

b) Plans for appropriate and timely consultation by members ofthe MDT with reference to patient acuity based on expectedoutcome for clinical condition.

c) Utilises specific evidence based criteria for the evaluation ofexpected outcomes of acute illness and injury.

DOMAIN 2: HOLISTIC APPROACHES TO CAREAND INTEGRATION OF KNOWLEDGE

Performance Criteria

2.1 Conducts a systematicholistic assessment of theneeds of the emergencypatient based on nursingtheory and evidence-basedpractice.


a) Performs a biophysical and psychosocial (holistic)assessment of the emergency patient taking intoconsideration the life long continuum.

b) Performs the holistic assessment based on agreed modelsof care and using validated assessment tools, e.g.Manchester Triage System, National Early Warning Score,Glasgow Coma Scale Score, pain assessment tools.

c) Performs patient assessments procedures as required e.g.ECGs, venepuncture, blood gases.

d) Integrates and applies knowledge of acute life and limbthreatening conditions into holistic patient assessment.

e) Interprets data accurately and comprehensively leading toappropriate diagnoses and interventions.

f) Knows own limitations and seeks guidance whereappropriate.


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d) Incorporates best practice standards and research directlyrelated to caring for the emergency patient.

e) Documents plan of care in a clear concise manner.

f) Involves the patient and where appropriate carer/family informulating their plan of care.

g) Ensures patient is informed and updated regarding theirplan of care.

h) Refers to protocols governing receipt of patient from pre-hospital ambulance service, the length of stay in ED,transfer of patient to ward or discharge.

2.3 Implements plannednursing care andinterventions to achieveidentified outcomes.

a) Implements plan of care and reassess the patient to ensuregoal sets are being met.

b) Provides person-centred and family-centred nursing care.

c) Provides appropriate interventions for patients attending theED within his/her scope of practice e.g. IV cannulation,application of orthopaedic cast, prescribing of medicinalproducts by a registered nurse prescriber, medicationadministration through use of medication protocols, malecatheterisation, prescribing of ionising radiation byappropriately trained nurses... etc.

d) Adheres to professional practice guidelines in themanagement and administration of all medication.

e) Adheres to professional practice guidelines in themanagement of patients who present as result of violenceor abuse.

f) Identifies and implements infection prevention and controlopportunities.

g) Use opportunities to promote health and wellbeing asappropriate.

h) Creates and maintains a safe and comfortable environmentthat provides for the physical, psychosocial and spiritualneeds of the patient. This includes care of the dying/end oflife patient.

i) Maintains the dignity, comfort and privacy of thefamily/relatives of the deceased patient in the ED.

2.4 Evaluates progresstoward expected outcomesand reviews plan of care inconsultation with theemergency patient.

a) Assesses the effectiveness of emergency nursing care inachieving planned outcomes.

b) Continually evaluates effectiveness of nursing interventionsand compares actual with anticipated outcomes usingassessment tools as appropriate.

c) Provides evidence based rationale to modify andindividualise the care plan according to evaluation findings.

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DOMAIN 3: INTERPERSONAL RELATIONSHIPSPerformance Criteria

3.1 Establishes and maintainscaring therapeuticinterpersonal relationshipswith the emergency patient,family/carers.


a) Promotes collaborative communication with the patient andtheir family/carers.

b) Communicates meaningfully and sensitively, supporting theemergency patient in the expression of their feelings, fearsand expectations.

c) Provides emotional and social support to emergencypatient, family/carers.

d) Ensures the emergency patient and family/ carers receiveand understand relevant and current information concerningtheir health care/needs and are involved where appropriatein decisions of care.

e) Appreciates the barriers to communication due to, forexample, the critical condition of emergency patient orphysical/mental disability.

f) Identifies barriers to communication such as deafness,language barrier, aphasia, cognisance difficulties andinstigates alternative communication channels/tools.

g) Demonstrates strong listening and sensing skills.

h) Safeguards and ensures confidentiality, privacy andinformed consent.

i) Following the death of the emergency patient providessupport for the carer's and facilitates transition intobereavement/support services, if required.

j) Maintains dignity and privacy following death,accommodating and being respectful and sensitive to thecarers’ cultural and spiritual diversities.

3.2 Collaborates with allmembers of themultidisciplinary team anddocuments relevantinformation.

a) Establishes relationships with MDT members andcontributes collaboratively in decision-making concerningpatient care.

b) Demonstrates effective verbal communication withmembers of the MDT to ensure continuity of care throughan entire care episode.

c) Advocates on the patients behalf with the MDT.

d) Can make a compelling case to positively influence thethinking of others.

e) Maintains comprehensive, accurate, clear, conciseemergency nursing records within a legal and ethicalframework (An Bord Altranais 2002).


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3.3 Demonstrates effectivecommunication skills.

a) In the interest of patient safety the staff nurse in theemergency setting ensures accurate and timely transfer ofinformation with:-

Pre-hospital emergency care/ambulance staff usingpolicies and guidelines promoted by the NationalEmergency Medicine Programme (EMP) and PreHospital Emergency Care Council (PHECC).

All members of the multidisciplinary ED team (adheringto internal ED communication protocol).

Relevant medical, nursing, allied health and support staffexternal to the ED team and understand the role of thesepersonnel and their contribution to the care ofemergency patient.

With Acute Medical Assessment Unit, Critical Care,Operating theatre and ward staff to ensure efficient andeffective handover of patient information.

b) Recognises the barriers to effective communication andtake appropriate actions to overcome these barriers.

c) Understands the interdependence of nursing with otherprofessions required to deliver the best patient service.

d) Communicates in a patient and family centered manner withemergency patients.

e) Demonstrates effective verbal and written skills.

f) Demonstrates ability in the handling of and positiveresolution of conflict.

DOMAIN 4: ORGANISATION ANDMANAGEMENT OF CARE


4.1 Effectively managesnursing care of theemergency patient within themulti-disciplinary team.


a) Contributes to the overall mission and goal of theemergency department and organisation.

b) Holds an appropriate and effective set of managerial valuesand beliefs and behaves in line with these.

c) Maintains a disciplined and professional level ofperformance under sustained situational pressure.Demonstrates resilience and composure in stressful, hightension situations.

d) Demonstrates effective and efficient management of ownwork/case load.

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e) Assumes responsibility for effectively managing andsupporting more junior staff, nursing students and nursingsupport staff delegated to his/her supervision.

f) Takes opportunities to develop management skills.

g) Identifies risks and reports adverse incidents according tolocal policy.

h) Looks ahead and anticipates service pressures and potentialcare needs.

i) Collaborates with other MDT members in providing bestpractice and establishes mechanisms for consultationregarding practice and referral.

j) Follows and adheres to Hygiene, Health and Safety,Infection Prevention and Control standards and guidelines.

4.2 Facilitates the co-ordination of care embracingthe emergency patients’choices and involvement.

a) In conjunction with the patient, seeks to determineindividual choices and preference regarding their personal care plan.

b) Works with multi-disciplinary team members to ensure thatcare is appropriate, effective, safe and consistent.

c) Liaises and works with agencies providing care for theemergency patient e.g. liaison psychiatry, crisisintervention team, primary care teams, pre-hospitalemergency care services, support agencies.

d) Participates in quality initiatives e.g. patient satisfactionsurveys and audit.

e) Educates the patient regarding relevant focusgroups/networks that they can avail of.

DOMAIN 5: PERSONAL AND PROFESSIONALDEVELOPMENT


5.1 Acts to enhance thepersonal and professionaldevelopment of self andothers.


a) Acknowledges the need for professional and personaldevelopment and actively pursues opportunities to avail ofpersonal development.

b) Demonstrates a commitment to ongoing professionaleducation and life-long learning in the care of theemergency patient.

c) Demonstrate self awareness, recognising the impact of ownand others attitudes, values and expectations on nursingcare of the emergency patient and their carer/family.


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d) Demonstrates clarity of beliefs and values in caring for theemergency patient.

e) Learns quickly from experience. Has the ability to reflect onincidents and situations so as to debrief self and others inorder to learn and find better ways of doing things.

f) Contributes to the learning experience of colleagues througha supportive and collaborative framework.

g) Participates in and uses the outcomes of audit andeducation initiatives to improve nursing care of theemergency patient.

h) Develops professional links and networking with othersprofessionals practicing in the emergency setting

i) Demonstrates ability to embrace the evolving role of the EDstaff nurse.

j) Recognises the requirement for team work, effectivecommunication and an understanding of theinterdependence with other disciplines in an ED setting inthe provision of safe patient care.

5.2 Participates in educationand professional developmentprogrammes in care of theemergency patient.

a) Participates in and accepts personal responsibility forongoing professional development and education in the careof the emergency patient.

b) Collaborates with other multi-disciplinary team memberswho have expert knowledge in providing best practice andestablishing a forum for delivery of education.

5.3 Develops and integrates aframework to reflect onpractice, implementingevidence-based nursingpractice to improve the careof the emergency patient.

a) Values and establishes reflective practice as an integral partof nursing care of the emergency patient.

b) Develops and integrates a framework to reflect on, andexplore, nursing practice in care of the emergency patient.

c) Objectively evaluates emergency nursing practice.

d) Integrates evidence-based practices to improve nursingcare of the emergency patient.

e) Contributes to local initiatives to enhance reflection e.g.case study reviews, journal clubs etc.

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ROLE PROFILE

NURSING SHIFT LEADERIN THE EMERGENCY

SETTING

This is a complementary document to theHSE nationally agreed job specifications(Grade code 2127 CNM 1 and Grade code2119 CNM2).



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b) Integrates accurate and comprehensive knowledge ofethical principles and the Code of Professional Conduct(2000) within the Scope of Professional Practice (2000) inthe delivery of emergency nursing care.

c) Advocates with and on behalf of the emergency patient toprotect their rights.

d) Promotes and supports the implementation of thephilosophies, policies, protocols and clinical guidelines ofthe healthcare institution and those specific to theemergency department.

e) Provides and promotes a high level of professional andclinical leadership within the emergency setting and thewider health service.

f) Promotes and supports the utilisation of evidence basedemergency care to improve patient outcomes, reducesvariation in practice and informs & improves quality ofclinical decisions.

g) Monitors, responds to and manages and/or reports allincidences of unsafe or unprofessional practice anddeviations from best practice.

h) Demonstrates prompt active management of unethical andunprofessional practices in the ED.

i) Adheres to and promotes best practice in the managementof patient safety, risk assessment, risk minimisation andrisk management and promotes safety at all times.

j) With the support of education staff (where available), co-ordinates and supervises the preceptorship of studentnurses and junior staff nurses in the ED and contributes tothe education of other multidisciplinary team members.


a) Determines own scope of practice using the principles inthe Scope of Nursing and Midwifery Practice Frameworkdocument (2000).

b) Recognises own abilities and level of professionalcompetence and uses every opportunity to enhance these.

c) Critically reflects on and evaluates own practice and practiceof direct reports and ensure this practice is based on bestavailable evidence.

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d) Accepts responsibility and accountability for consequencesof own actions or omissions and those of direct reportswhilst caring for the emergency patient.

e) Assumes personal responsibility for maintaining currentknowledge to provide evidence-based, best clinical andmanagerial practice emergency nursing.

f) Promotes and monitors maintenance of knowledge andskills of direct reports.

1.3 Holds an appropriate setof professional andmanagerial beliefs andpractices in line with theseand promotes and supportsethical and values based staffpractices.

a) Makes a positive contribution to the development of ethicsand values at both professional and organisational level.

b) Demonstrates a commitment to service excellence within theemergency setting and hospital.

c) Holds an appropriate set of professional values and beliefsand behaves in line with these values (guided by the Code ofProfessional Conduct for each Nurse and Midwife An BordAltranais 2000).

d) Ensures that actions and behaviours are consistent with theespoused values of the ED and organisation.

e) Shows proficiency and professionalism in dealing with directreports, other members if the ED multidisciplinary team,hospital/community healthcare staff and patients,families/carers.

f) Acknowledges mistakes and implement proactive measuresto prevent reoccurrence.



2.1 Supports and monitorsemergency nursing clinicalstaff in conducting systematicholistic assessments of theneeds of the emergencypatient based on nursingtheory and evidence-basedpractice.


a) Endorses and supports emergency nursing in performingholistic assessment based on agreed models of care.

b) Supports clinical nursing staff in the use of validatedassessment tools, e.g. Manchester Triage System, GlasgowComa Scale Score, pain assessment tools, EMP clinicaltools etc.

c) Acts as a role model at all times, provides support andmonitors clinical staff in performing assessment of theemergency patient, interpretation of data and integration ofknowledge.

d) Uses opportunities and guidance from the EMP and otherrelevant clinical care programme to promote the use ofevidence based practice and best practice standards for theemergency patient by all staff.


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2.2 Supports the emergencynurse in planning care inconsultation with the patienttaking into consideration theinput of members of variousmultidisciplinary teams.

a) Supports the emergency nurse in prioritising care of theemergency patient based on their immediate needs andbest/ evidence-based practice.

b) Assists junior nursing staff in the planning for appropriateand timely consultation by members of the MultiDisciplinary Team (MDT) with reference to patient acuitybased on expected outcome for clinical condition andoutline the requirement for timely management of patientcare.

c) Promotes the utilisation of evidence based criteria for theevaluation of expected outcomes of acute illness and injury.

d) Monitors and audits care planning documentation for EDpatients and ensure high standard is maintained.

e) Advocates patient involvement in their plan of care or in thesituation of the child promote family centred care approach.

2.3 Monitors theImplementation of nursingcare and interventions byemergency nursing clinicalstaff to achieve identifiedoutcomes and ensure highstandard of care is delivered.

a) Manages the workload of the department by assisting staffin the implementation of plan of care for ED patients andhighlight the importance of reassessment of the patient toensure goal sets and ED targets are being met.

b) Advocates person-centred and family-centred nursing carewithin the emergency setting.

c) Ensures nursing staff provide appropriate interventions forpatients attending the ED e.g. IV cannulation, application oforthopaedic casts, medication administration through use ofmedication protocols, male catheterisation etc.

d) Monitors/ audits and ensures adherence to professionalpractice guidelines, local policies and standards by qualifiedstaff that are authorised to prescribe medicinal productsand ionising radiation.

e) Ensures adherence to professional practice guidelines in themanagement of patients who present as result of violenceor abuse or in the case of a child has child protectionissues.

f) Advocates the promotion of health and wellbeing to allemergency patients.

g) Monitors the environment to ensure nursing staff create andmaintain a safe and comfortable environment that providesfor the physical, psychosocial and spiritual needs of thepatient (in a family centred care manner where appropriate).This includes care of the dying patient and end of life patientcare.

h) Promotes the maintenance of dignity, comfort and privacyof the family/relatives of the deceased patient in the ED.

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2.4 Supports emergencynurses in optimally evaluatingpatient progress towardexpected outcomes andadvocate regular review of theplan of care in consultationwith the emergency patient.

a) Ensures nurses are assessing the effectiveness of theiremergency nursing care in achieving planned outcomes.

b) Ensures nurses are continually evaluating effectiveness ofnursing interventions and comparing actual with anticipatedoutcomes using assessment tools as appropriate.

c) Monitors the provision of evidence based rationale tomodify and individualise care plans according to evaluationof findings.

d) Evaluates the management and implementation of bestpractice policy and procedures.

2.5 Promotes evidence baseddecision making.

a) Uses analysis and logic in considering problems and issuesthat present in the ED.

b) Uses a wide range of information sources and knows howto access relevant information.

c) Takes an overview of complex problems before generating asolution and anticipates the impact of different solutions.

d) Makes decisions in a timely manner in a pressurised andtime constrained environment.

e) Actively and efficiently recognises and addresses staffissues as they emerge.

DOMAIN 3: INTERPERSONAL RELATIONSHIPS


3.1 Establishes and maintainscaring therapeuticinterpersonal relationshipswith the emergency patient,family/carers.


a) Promotes clear and collaborative communication with theED MDT, the wider healthcare hospital/community team andthe patient, family/carers.

b) Invites feedback from patients and their families/carers andcreates opportunities for patients to discuss their care.

c) Ensures the ED nursing team communicates meaningfullyand sensitively, supporting the emergency patient andfamily/carers in the expression of their feelings, fears andexpectations.

d) Advocates the provision of emotional and social support byrelevant ED team members to the emergency patient andfamily/carers.

e) Ensures the emergency patient and carer/family receive andunderstand relevant and current information concerning theirhealth care/needs and are involved in decisions of care.

f) Safeguards and ensures confidentiality, privacy andinformed consent.


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g) Articulates the needs of the patients clearly and is a strongadvocate for the ED patient.

h) Supports the education of emergency patients regardingrelevant focus groups/networks that they can avail of.

i) Assists patients in a professional manner.

j) Provides and ensures staff provide a caring andcompassionate service.

3.2 Communicatesstrategically and fluently.

a) Organises information logically to make a persuasive case.

b) Builds and uses networks across sectors and disciplines.

c) Constructs effective written and oral communications thatare appropriate to target audience.

d) Maintains comprehensive, accurate, clear, conciseemergency nursing records within a legal and ethicalframework (An Bord Altranais 2002) and complies with HSEStandards for Healthcare Records Management (HSE 2011QPSD-D-006-3 V 3.0).

e) Maintains collaborative networking and communication on aproactive basis to support patient flow e.g. with pre hospitalstaff, primary care agencies and internal hospital staff/departments (scheduled and unscheduled) i.e. bedmanagement, AMAUs, ICUs, day units, OPD, wards etc.



4.1 Effectively managesnursing care of theemergency patient within themulti-disciplinary team.


a) Works collaboratively with ED and hospital teams towardsachieving the National Standards for Better Safer Healthcare2012.

b) Contributes to and leads on the overall purpose andobjectives of the ED and organisation.

c) Collaborates MDT members in providing effective practiceand establishes mechanisms for consultation regardingpractice and referral.

d) Co-ordinates department activities to ensure ED quality andaccess standards are achieved and supports and maintainsfocus on performance delivery, accountability andawareness of quality and access standards during a shift.

e) Is self motivated and accepts and performs care provisionas appropriate in a timely and efficient manner.

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f) Links regularly and proactively with Hospital BedManagement and ward/ICU/AMAU colleagues to optimisepatient flow.

g) Creates a positive working climate that exemplifiesrespectful interdisciplinary and interdepartmental working,learning and development.

h) Encourages a culture of finding better ways to meet eachemergency patients needs.

i) Identifies risks and reports adverse incidents according tolocal and national policy.

j) Adheres to and supports audit of Hygiene, Health andSafety, Infection Prevention and Control standards andguidelines for the emergency setting.

k) Participates in/leads on appropriate clinical audit.


a) Works with multi-disciplinary team members to ensure thatcare for emergency patients is appropriate, effective, safeand consistent on a day-to-day basis.

b) Liaises and works with agencies providing care for theemergency patient e.g. liaison psychiatry,crisis interventionteams, primary care teams, pre-hospital emergency careservices, support agencies.

c) Leads and drives quality and process improvementinitiatives e.g. patient satisfaction surveys, audit, ClinicalMicrosystem Quality Improvement Coaching etc.

4.3 Builds effective teams,blending diverse styles into acohesive unit bycommunicating with andempowering staff.

a) Is a positive team member, recognises when colleaguesrequire assistance, builds relationships and partnershipswhich recognise interdependencies and demonstrateswillingness to assist in a positive manner.

b) Provides a regular forum for staff communication e.g.conducting regular meetings and facilitating ‘huddle’sessions to problem solve and improve quality and patientsafety.

c) Develops ED nursing staff to full potential by devolvingauthority and responsibility within professional limits.

d) Models effective work practices and uses his/her skills toeducate others.

e) Advocates learning to work in an interdisciplinary manner todesign and provide patient care.

f) Is aware, takes guidance on and actively supports theprofessional and organisational agendas.


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4.4 Maintains a disciplinedand professional level ofperformance, particularlyunder sustained or situationalpressure.

a) Puts coherence and structure on the response to crisissituations thereby giving staff the confidence of being led ina crisis.

b) Deals with unexpected situations or crises in a flexible andfluent way.

c) Maintains an objective perspective when dealing withdifferences of opinion/conflict.

d) Demonstrates competence in resolving conflict and inconducting successful negotiation and mediation.

e) Supports and coaches staff on how to react appropriately intimes of crisis.

f) Identifies and reports complaints according to local policyand investigates and/or supports any resulting change thatmay be required.

4.5 Ensures that criticalhuman and materialresources are allocated in aneffective way, monitorsactivity levels and intervenesto align resources tomaximise efficiency.

a) Plans and maintains staff rotas and ensures alignment ofavailable resources to match demand.

b) Is resourceful in resolving ED staff shortage issues.

c) Effectively uses ICT systems to support resourcemanagement.

d) Co-ordinates and ensures safety checks and stocks arecompleted as per policy and relevant documentation andrecords maintained.





a) Acknowledges the need for professional and personaldevelopment and demonstrates a commitment to ongoingprofessional education for nurses in the care of theemergency patient and supports direct reports in identifyingand maintaining their professional development needs.

b) Demonstrates self awareness, recognising the impact ofown and others’ attitudes, values and expectations onnursing care of the emergency patient and their carer/family.

c) Facilitates staff development and contributes to the learningexperience of colleagues through a supportive andcollaborative framework.

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d) With the support of education staff, participates in and usesthe outcomes of education needs analysis and educationinitiatives to improve nursing care of the emergency patient.

e) Develops professional links and networking with othersprofessionals practicing in the emergency setting and otherunscheduled care settings.

f) Participates in performance management of direct reports.Sets expectations and encourages and develops staffthrough education and training.



b) Supports the framework for maintenance of competency asidentified by the Nursing and Midwifery Board of Ireland(NMBI) for nursing staff within the ED.

c) Identifies a mechanism to support continuing professionaldevelopment to ensure continued competence of one selfand staff reporting to him/her.

d) Collaborates with other MDT members who have expertknowledge in providing best practice in emergency care andestablishing a forum for delivery of education.

e) Ensures that learning is a central element of daily workwithin the ED and supports the concept of ‘on the jobtraining’.

f) Provides feedback to colleagues locally, nationally andinternationally on research carried out in your own ED asappropriate.

5.3 Develops and integrates aframework to reflect onpractice, implementingevidence-based nursingpractice to improve the careof the emergency patient.

a) Supports the integration of evidence-based practices to inform and improve nursing care of the emergency patient.

b) Values, promotes and establishes reflective practice as anintegral part of nursing care of the emergency patient.

c) Contributes to local initiatives to enhance reflection e.g.case study reviews, journal clubs etc.

d) Promotes objective evaluation of emergency nursingpractice as appropriate.


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5.4 Demonstrates leadershipin change.

a) Balances the need for transactional management withtransformational leadership.

b) Supports the implementation of the EMP model of care andrecommendations within the ED.

c) Acts primarily as a clinical leader role model for emergencynurses and demonstrates a high managerial competenceand confidence in carrying out his/her role.

d) Actively contributes to the clinical governance of thedepartment in line with the role, responsibilities,accountability and autonomy.

e) On a shift, aligns staff, processes and systems to achieveED targets, best patient outcomes and departmental goals.

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ROLE PROFILE

NURSE MANAGER IN THE EMERGENCY SETTING

This is a complementary document to theHSE nationally agreed job specifications(Grade code 2119 CNM2 and Grade code233X CNM3).



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b) Integrates accurate and comprehensive knowledge ofethical principles and the Code of Professional Conduct(2000) within the Scope of Professional Practice (2000) inthe delivery of emergency nursing care.

c) Advocates with and on behalf of the emergency patient toprotect their rights.

d) Promotes and supports the implementation of thephilosophies, policies, protocols and clinical guidelines ofthe healthcare institution and those specific to the ED.

e) Provides and promotes a high-level of professional andclinical leadership within the emergency setting and thewider health service.

f) Promotes and supports the utilisation of evidence basedemergency care to improve patient outcomes, reducesvariation in practice and improves quality of clinicaldecisions.

g) Monitors, responds to and manages and/or reports allincidences of unsafe or unprofessional practice anddeviations from best practice.

h) Demonstrates prompt active management of unethical andunprofessional practices in the ED.

i) Adheres to and promotes best practice in the managementof patient safety, risk assessment, risk minimisation andrisk management and promotes safety at all times.

j) With the support of education staff (where available), co-ordinates and supervises the preceptorship of studentnurses and junior staff nurses in the ED and contributes tothe education of other multidisciplinary team members.


a) Determines own scope of practice using the principles inthe Scope of Nursing and Midwifery Practice Frameworkdocument (2000).

b) Recognises own abilities and level of professionalcompetence and uses every opportunity to enhance these.

c) Critically reflects on and evaluates own practice and practiceof direct reports and ensure this practice is based on bestavailable evidence.

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d) Accepts responsibility and accountability for consequencesof own actions or omissions and those of direct reportswhilst caring for the emergency patient.

e) Assumes personal responsibility for maintaining currentknowledge to provide evidence-based, best clinical andmanagerial practice in emergency nursing.

f) Promotes and monitors maintenance of knowledge andskills of direct reports.

1.3 Holds an appropriate setof professional andmanagerial beliefs andpractices in line with theseand promotes and supportsethical and values based staffpractices.

a) Makes a positive contribution to the development of ethicsand values at both professional and organisational level.

b) Demonstrates a commitment to service excellence withinthe emergency setting and hospital.

c) Ensures that actions and behaviours are consistent with theespoused values of the ED and organisation.

d) Follows through on issues and practices in a manner that isconsistent with own and ED/organisations espoused values.

e) Shows proficiency and professionalism in dealing withdirect reports, other members of the ED multidisciplinaryteam, hospital/community healthcare staff and patients,families/carers.

f) Acknowledges mistakes and implement proactive measuresto prevent reoccurrence.



2.1 Supports and monitorsemergency nursing clinicalstaff in conducting systematicholistic assessments of theneeds of the emergencypatient based on nursingtheory and evidence-basedpractice.


a) Endorses and supports emergency nursing in performingholistic assessment based on agreed models of care.

b) Supports clinical nursing staff in the use of validatedassessment tools, e.g. Manchester Triage System, GlasgowComa Scale Score, pain assessment tools, EMP clinicaltools etc.

c) Acts as a role model at all times, provides support andmonitors clinical staff in performing assessment of theemergency patient, interpretation of data and integration ofknowledge.

d) Uses opportunities and guidance from the EMP and otherrelevant National Clinical Programmes to promote the useof evidence based practice and best practice standards forthe emergency patient by all staff.


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a) Oversees the utilisation of evidence based criteria for theevaluation of expected outcomes of acute illness and injury.

b) Supervises implementation of care planning documentationfor ED patients, ensures high standards are maintained andmanages any changes required.

c) Advocates patient involvement in their plan of care or in thesituation of the child promotes a family centred careapproach.

2.2 Supports the emergencynurse in planning care inconsultation with the patient,taking into consideration theinput of members of variousMDT.

a) Ensures nurses are assessing the effectiveness of theiremergency nursing care in achieving planned outcomes.

b) Monitors the provision of evidence based rationale tomodify and individualise care plans according to evaluationof findings.

c) Evaluates the management and implementation of bestpractice policy and procedures.

d) Promotes the identification and use of opportunities toprotect and improve the health and well being of emergencypatients.

2.4 Supports emergencynurses in optimally evaluatingpatient progress towardexpected outcomes andadvocate regular review of theplan of care in consultationwith the emergency patient.

a) Advocates person-centred and family-centred nursing carewithin the emergency setting.

b) Monitors implementation and manages adherence toprofessional practice guidelines in the management andadministration of all medication.

c) Monitors and ensures adherence to professional practiceguidelines, local policies and standards by qualified staffthat are authorised to prescribe medicinal products andionising radiation.

d) Supervises implementation of and monitors adherence toprofessional practice guidelines in the management ofpatients who present as result of violence or abuse or in thecase of a child who has child protection issues.

e) Advocates the promotion of health and wellbeing of allemergency patients.

f) Monitors the environment to ensure nursing staff create andmaintain a safe and comfortable environment that providesfor the physical, psychosocial and spiritual needs of thepatient (in a family centred care manner where appropriate).This includes care of the dying patient and end of life patientcare.

g) Promotes the maintenance of dignity, comfort and privacyof the family/relatives of the deceased patient in the ED.

h) Ensures staff have appropriate preparation/training in allPolicies, Protocols, Procedures and Guidelines (PPPGs)relevant to nursing practice in the ED.

2.3 Monitors theImplementation of nursingcare and interventions byemergency nursing clinicalstaff to achieve identifiedoutcomes and ensure highstandard of care is delivered.

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a) Uses analysis and logic in considering problems and issuesthat present in the ED.

b) Uses a wide range of information sources and knows howto access relevant information.

c) Takes an overview of complex problems before generating asolution and anticipates the knock on effects of differentsolution.

d) Makes decisions in a timely manner in a pressurised andtime constrained environment.

e) Actively and efficiently recognises and addresses staffissues as they emerge.

2.5 Promotes evidence baseddecision making.

a) Personally champions change/quality improvement projectsand service initiatives.

b) Promotes nursing as a leader or significant contributor ininterdisciplinary service improvement projects.

c) Engages with ED team and Clinical Operational Group (COG)on a regular basis to develop solutions to service issues orproblems.

d) Demonstrates a flexible approach, leads change, championsnew ideas and ways of working.

e) Empowers staff through team meetings, coaching,education and promotion of staff initiatives.

2.6 Drives to achieve positiveresults and move the serviceforward.

DOMAIN 3: INTERPERSONAL RELATIONSHIPS


3.1 Advocates caringtherapeutic interpersonalrelationships with theemergency patient, familyand/or carers.


a) Promotes clear and collaborative communication with theED multidisciplinary team, the wider healthcarehospital/community team and the patient, family/ carers.

b) Creates opportunities for patients to discuss patient careand seeks feedback from patients, their families and carers.

c) Articulates the needs of the patients clearly and is a strongadvocate for the ED patient.

d) Advocates meaningful patient focus and public involvementincluding consulting with communities.

e) Instills a focus on the culture of caring and the delivery ofcompassionate care.


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f) Puts in place a structured communication andimplementation strategy for complex issues.

g) Organises information logically to make a persuasive case.

h) Builds and uses networks across sectors and disciplines.

i) Constructs effective written and oral communications thatare appropriate to target audiences.

j) Maintains comprehensive, accurate, clear, conciseemergency nursing records within a legal and ethicalframework (An Bord Altranais 2002) and complies with HSEStandards for Healthcare Records Management (HSE 2011QPSD-D-006-3 V 3.0).

k) Creates and maintains collaborative networking andcommunication on a proactive basis to support patient flowe.g. with pre hospital staff, primary care agencies andinternal hospital staff/departments (scheduled andunscheduled) i.e. bed management, AMAUs, ICUs, dayunits, OPD, wards etc.

3.2 Communicatesstrategically and fluently.



4.1 Effectively managesnursing care of theemergency patient within theMDT.


a) Works collaboratively with ED and hospital teams towardsachieving the National Standards for Better Safer Healthcare2012.

b) Contributes to achieving the overall purpose and objectivesof the emergency department and organisation.

c) Leads on the monitoring of and progress towards achievingED quality and access standards.

d) Collaborates with other MDT members in providing bestpractice and establishes mechanisms for consultationregarding practice and referral.

e) Links regularly and proactively with Hospital BedManagement and ward/ICU/AMAU colleagues to optimisepatient flow.

f) Is self-motivated and accepts and performs care provisionas appropriate in a timely and efficient manner.

g) Creates a positive working climate that exemplifiesrespectful interdisciplinary interdepartmental working,learning and development.

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a) Works with MDT members to ensure that care foremergency patients is appropriate, effective, safe andconsistent.

b) Liaises and works with agencies providing care for theemergency patient e.g. liaison psychiatry, crisis interventionteam, primary care teams, pre-hospital emergency careservices, support agencies.

c) Leads and drives quality and process improvementinitiatives e.g. patient satisfaction surveys, audit, ClinicalMicrosystems Quality Improvement Coaching etc.


a) Puts coherence and structure on the response to crisissituations thereby giving staff the confidence of being led ina crisis.

b) Deals with unexpected situations or crises in a flexible andfluent way.

c) Resolves complex problems to achieve constructive andpositive outcomes.

d) Maintains an objective perspective when dealing withdifferences of opinion/conflict.

e) Supports and coaches staff on how to react appropriately intimes of crisis.

4.4 Maintains a disciplinedand professional level ofperformance, particularlyunder sustained or situationalpressure.

a) Leads on EMP and organisational vision and supportsimplementation of recommendations by setting clearobjectives for emergency service delivery.

b) Aligns professional and organisational agendas.

c) Is a positive team member, recognises when colleaguesrequire assistance, builds relationships and partnershipswhich recognise interdependencies and demonstrateswillingness to assist in a positive manner.

d) Provides a regular forum for staff communication e.g.conducting regular meetings and facilitating communicationsessions (huddle/safety pause) to problem solve andimprove quality and patient safety.

e) Develops ED nursing staff to full potential by devolvingauthority and responsibility within professional limits.

f) Models effective work practices and uses his/her skills toeducate others.

g) Advocates learning to work in an interdisciplinary manner todesign and provide patient care.

h) Ensures the provision of ongoing quality improvement in EDNursing.

4.3 Builds effective teams,blending diverse styles into acohesive unit bycommunicating with andempowering staff.


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f) Monitors and investigates complaints according to localpolicy and drives any resulting change that may be required.

a) Plans and maintains staff rotas and ensures alignment ofavailable resources to match demand.

b) Implements effective monitoring systems for all keyresource usage.

c) Consistently achieves efficiencies in resource usage throughtactical deployment, monitoring and adjustments.

d) Is resourceful in managing ED staff shortage issues butidentifies and reports situations of risk related to resourceavailability.

e) Identifies areas for savings which may be used to redeployresources for further service improvement.

f) Effectively uses ICT systems, as available, to supportresource management.

g) Explores the development and expansion of nursing andsupport roles in the ED in response to the emerging needsof ED patients.

h) Initiates training programmes to provide staff with the skillsand knowledge required to progress patient and processimprovement.

4.5 Ensures that criticalhuman and materialresources are allocated in aneffective way to ensurepatient safety, monitorsactivity levels and intervenesto align resources tomaximise efficiency.





a) Acknowledges the need for professional and personaldevelopment and demonstrates a commitment to ongoingprofessional education for nurses in the care of theemergency patient and supports direct reports in identifyingand maintaining their professional development needs.

b) Demonstrates self awareness, recognising the impact ofown and others attitudes, values and expectations onnursing care of the emergency patient and their carer/family.

c) Facilitates staff development and contributes to the learningexperience of colleagues through a supportive andcollaborative framework.

d) With the support of education staff (if available) participatesin and uses the outcomes of education needs analysis andeducation initiatives to improve nursing care of theemergency patient).

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e) Develops professional links and networking with othersprofessionals practicing in the emergency and otherunscheduled care settings.

f) Participates in performance management of direct reports.Sets expectations and encourages and develops staffthrough education and training.

g) Supports succession planning by identifying, supportingand developing future leaders.


b) Supports the framework for maintenance of competency asidentified by the Nursing and Midwifery Board of Ireland(NMBI) for nursing staff within the ED.

c) Identifies a mechanism to support continuing professionaldevelopment to ensure continued competence of self andstaff reporting to him/her.

d) Collaborates with other MDT members who have expertknowledge in providing effective practice in emergency careand establishing a forum for the delivery of education.

e) Ensures that learning is a central element of daily workwithin the ED and supports the concept of ‘on the jobtraining’.

f) Provides feedback to colleagues locally, nationally andinternationally on research carried out in your own ED asappropriate.


a) Is an inspirational leader and acts as a role model foremergency nursing staff.

b) Balances the need for transactional management withtransformational leadership.

c) Leads on the implementation of the EMP model of care andrecommendations within the ED .

d) Leads on the implementation of clinical governancearrangements with clearly defined roles and responsibilitieswithin the emergency setting.

e) Demonstrates competence in resolving conflict and inconducting successful negotiation and mediation.

f) Aligns people, structures, systems and processes to securegoals.

5.3 Demonstrates leadershipin change.


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l) Maintains an improvement-orientated environment bycontinuously assessing processes, behaviours andoutcomes and by discussing and evaluating specificchanges in light of consultation with and feedback fromstaff and by instilling confidence in ED staff that they havethe ability to deliver improvement.

m) Is competent in the use of the tools and techniques ofchange management such as effective meeting skills,project management, financial management, processmapping, implementation planning and use of ICT.

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Document number Role Profiles 2014 - 001

Date issued January 2014

Summary This document is a complementary document to the HSEnationally agreed job specification staff nurse (general)(Grade code 2135) CNM 1 (Grade code 2127), CNM2(Grade code 2119), and CNM 3 (Grade code 233X)

Authors Emergency Nursing Interest Group/Emergency MedicineProgramme

Contact [email protected]

Applies to ED Staff - Nursing

Audience Office of the Nursing and Midwifery Services Director(ONMSD), ENIG, HSE Human Resources Directorate,HSE Regional Directors of Performance and Integration,Acute hospital CEOs/General Managers/OperationalManagers, Clinical Directors, Directors of Nursing,Consultants in Emergency Medicine, Clinical andAdministrative staff involved in EDs, Local Injury Unitsand Emergency Care Networks, IAEM

Approved by Emergency Nursing Interest Group/Emergency MedicineProgramme/Director of Nursing and Midwifery ReferenceGroup/ONMSD

Document status Final Guidance document

Contents Guidance for Nursing Roles in Emergency DepartmentsFive domains of Competence, Performance Criteria &Behavioural Indicators

Associated documents National Emergency Medicine Report 2012


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